Browsing by Author "Stevanović, Vladan (59131919800)"

Background/Aim. Posterior cruciate ligament is the primary stabilizer of the posterior tibia translation and secondary stabilizer of external tibial rotation as well as varus, valgus knee angulation. It is the strongest ligament in the knee that hurts the rarest. The aim of this study was to show the indications for surgery, present the surgical technique and give results of surgical treatment of posterior knee instability. Methods. The study icluded 12 patients who were tretaed surgically for posterior knee instabilility at the Institute for Orthopaedic Surgery “Banjica“, Belgrade, in the period from 1st January 2010 to 1st January 2014. All of them had arthroscopically assisted anatomic reconstruction of posterior crucuate ligament done with 4-strand hamstring tendon graft. Postoperative follow-up lasted approximately 42 months and Lysholm values and International Knee Documentation Committee (IKDC) score were compared as well as the clinical status. Results. All treated patients had Grade III of posterior instability. Combined injuries of the posterolateral corner and anterior cruciat ligament (75%) were very frequent. Preoperative mean value of Lysholm score was 45.92 and postoperative 85.92 what was statistically significant improvement, the same as subjective IKDC score whose mean value was 38.58 preoperatively and 89.75 after the surgery and rehabilitation. Clinical examination showed better posterior knee stability although in 50% of patients certain level of instability remains. Conclusion. Arthroscopic reconstruction with 4-strand hamstring tendon gives satisfactory result with posterior cruciate ligament reconstruction. The result of subjective feeling of patient is much better then objective clinical examination. Although surgical procedure is technically demanding, with physically active patients having grade III of posterior instability it provides better result than non-surgical treatment. © 2018, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

The semitendinosus (ST) and gracillis (Gr) tendons are commonly used as a replacement graft during the anterior cruciate ligament (ACL) reconstruction. There are many advantages of using the hamstrings tendons, including the ease of harvesting, suitable morphology for use as a graft, lower donor site morbidity, early rehabilitation, and patient satisfaction. In most cases, the ST tendon can regenerate after harvesting, showing similar morphology to the native tendon. Although some researchers have demonstrated a loss of hamstring muscle strength in such patients, most investigators have found only slight differences between the operated and the controlateral side in the postoperative period. Recovery of the muscle strength after division of the ST and G tendons can be explained by a process of functional regeneration of the tendons or by compensatory hypertrophy of other knee flexors. Morphological changes including atrophy and shortening of the ST have been confirmed in patients with ACL reconstruction using the ST tendon. MRI analysis has indicated a surprising potential for the harvested tendons to regenerate, in particular when only the ST, and not the G, has been used for autologous transplant. Both in vitro and in vivo studies have illustrated "intrinsic" and "extrinsic" healing potential of the injured or surgically reconstructed tendon, although some have shown a regenerative process of the full-length tendon. The aim of this chapter was to present more information and morphologically document the regeneration ability of the semitendinosus after whole length and full thickness harvesting. The final question is if the quality of the regenerated tendons which resembled the normal ones would allow their use as a new graft. © 2018 Elsevier Inc. All rights reserved.

Introduction. An isolated fracture of the small tuberosity is a very rare injury that can often be overlooked. That injury is significant due to the function of the subscapularis muscle, which loses its attachment by separating the small tuberosity. Case report. A 45-year-old male, former athlete, suffered a left shoulder injury while falling downhill. Although the clinical picture was not convincing, a computed tomography scan showed a fracture. Open repositioning and osteosynthesis were performed. After rehabilitation, the patient regained a full active range of motion in the shoulder joint three months after the operation. We present the mechanism of injury, clinical picture, necessary diagnostics, and technique of surgical treatment of isolated fracture lesser tuberosity of the humerus. The results of other authors whose series are also quite small were analyzed. Conclusion. It was concluded that an isolated fracture of the small tuberosity requires surgical treatment to preserve a good range of motion in the shoulder joint. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction/Objective The knee joint is prone to injuries caused by direct or indirect trauma. The meniscus and ligament injuries, cannot be completely diagnosed with clinical examination; therefore, we use additional non-invasive and invasive diagnostic methods such as magnetic resonance imaging (MRI) and arthroscopy. The aim was to compare the accuracy of MRI and objective knee findings based on arthroscopic examination in case of meniscus and anterior cruciate ligament injuries. Methods The study involved 50 patients treated with elective surgery which mandatory involved arthroscopic visualization of the knee structures. We compared the MRI findings, obtained from different institutions, and arthroscopic knee findings for all the patients involved in the study. Results There were 50 patients included in the study with mean age of 31 years. MRI showed that Anterior cruciate ligament was damaged in 41 patients, while arthroscopy confirmed damage in 43 patients. Medial meniscus was damaged in 31 patients on MRI and in 27 on arthroscopic examination. Lateral meniscus was injured in 35 patients on MRI and arthroscopy showed damage in 32 patients. Using χ2 test we found no significant difference between MRI and arthroscopy as diagnostic methods. Wilcoxon signed-rank test shows similar results between MRI and arthroscopy findings. Conclusion A comparative analysis of MRI and arthroscopy diagnostic value in case of anterior cruciate ligament, medial meniscus and lateral meniscus injuries have shown that there is no significant difference between these two methods. © 2022, Serbia Medical Society. All rights reserved.

Introduction: Split tendon transfer of tibialis posterior (SPOTT) is a treatment option for the hindfoot varus deformity in patients with cerebral palsy (CP). The purpose of this study was to present the long-term results of the newly modified SPOTT procedure developed by our senior author and compare it with the standard SPOTT technique in equinovarus foot deformity due to CP. Method: Our retrospective cohort study included patients with spastic foot deformity due to CP treated with the standard or modified SPOTT technique. Patients’ age at the time of the surgery was ≥ five years with follow-up period of at least four years. Surgical outcomes were evaluated using Kling’s criteria during the patient’s last follow-up visit. Results: The analysis included 124 patients (146 feet), where 105 feet were treated by the standard SPOTT technique and 41 feet by the modified SPOTT technique. Patients’ median age at the time of the surgery was 11 years. Patients were followed-up for a median period of eight years during which the modified SPOTT technique showed significantly better surgical outcomes compared with the standard group (excellent/good results in 38 feet, 92.7%, vs. 79 feet, 75.2%, p = 0.02). Two groups of patients did not significantly differ in GMFCS level, age at the time of the surgery, or patient gender. There was similar distribution in CP patterns in the standard and modified groups; spastic hemiplegia was the most prevalent form, followed by spastic diplegia and spastic paraplegia. Overall, better surgical success was achieved in patients with GMFCS levels I–III (100%, 94.8%, and 69.8%, respectively). SPOTT procedure failure was frequently noticed in patients with GMFCS level IV (90.9%). Conclusion: The modified SPOTT procedure demonstrated efficiency and safety in patients with equinovarus foot deformity due to CP during the long-term follow-up. Compared with the standard procedure, the newly modified SPOTT technique showed significantly better surgical outcome, irrespective of the patients’ gender, age, initial GMFCS level, and CP type. © 2019, SICOT aisbl.

Purpose: It has been demonstrated that the semitendinosus tendon can regenerate after being harvested in its whole length and thickness for anterior cruciate ligament (ACL) reconstruction. Ultrasound studies and guided biopsies of the regenerated tendon have shown compatibility and resembling features of the normal tendon. The question is if this neo-tendon is biologically and functionally adequate for re-use? Methods: Two randomised groups of 150 volunteers were followed up for two years after harvesting the semitendinosus only (25) or the semitendinosus and gracilis tendons (25) in ACL reconstruction. The patients were followed up with clinical and ultrasound examinations, biopsies and histological tests. Surgical exploration was done in three patients for macroscopic verification. The injected arteries of four lower limbs were dissected and the tendon's arterial supplies were examined. Results: Seventy-two percent of the cases showed regeneration of the semitendinosus tendons. The neotendons were inserted mostly below the knee joint (83.3 %) where they had fused with the gracilis tendon, and above the joint (60 %) when the gracilis was harvested as well. The isokinetic strength of the hamstrings and quadriceps was not significantly diminished on the operated side. A macroscopic and histological analysis of the regenerated tendons demonstrates close resemblance to normal anatomy, with focal areas of fibrosis. In one patient the regenerated tendon was used for medial patellofemoral ligament reconstruction. Conclusion: The semitendinosus muscle can recover and the tendon has great potential to regenerate after harvesting for ACL reconstruction. Our data suggest that the regenerated tendons could be used for iterative ligament reconstruction. © 2013 Springer-Verlag Berlin Heidelberg.